Sever?s disease is the most common cause of heel pain in children aged 9 to 14. Sever?s disease results from stress placed on the growth plate of the heel bone. An excessive amount of running or other activities can cause inflammation around the growth plate, which results in pain. Rest, ice and orthotics and proper shoes are usually prescribed.
The usual cause is directly related to overuse of the bone and tendons in the heel. This can come from playing sports or anything that involves a lot of heel movement. It can be associated with starting a new sport, or the start of a new season, or too much weight bearing on the heel. Also, excessive traction could cause this, since the bones and tendons are still developing. Many children who over pronate their feet exhibit symptoms and in most patients, it usually involves both heels.
The most common symptoms of Sever?s involves pain or tenderness in one or both heels. This pain usually occurs at the back of the heel, but can also extend to the sides and bottom of the heel. A child with Sever?s may also have these common problems. Heel pain with limping, especially after running. Difficulty walking. Discomfort or stiffness in the feet upon awaking. Swelling and redness in the heel. Symptoms are usually worse during or after activity and get better with rest.
All medical diagnosis should be made by taking a full history, examining the patient then performing investigations. The problem usually occurs in boys who are going through or have just gone through a growth spurt; one or both heels may be affected. Initially the pain may be intermittent occurring only during or after exercise. As the problem gets worse, pain may be present most of the time. There may be swelling over the back of the heel and this area is painful if touched or knocked. On examination the patient often has flat feet, very tight legs muscles especially the gastrocnemius.
Non Surgical Treatment
Sever?s disease treatment should be based on eliminating pain and restoring normal foot and leg biomechanics. As with most soft tissue injuries the initial treatment is Rest, Ice, and Protect. In the early phase you?ll most likely be unable to walk pain-free. Our first aim is to provide you with some active rest from pain-provoking activities. "No Pain. No Gain." does not apply in Sever's disease. If it hurts your child is doing too much exercise. Your child should reduce or cease any activity that causes heel pain. Ice is a simple and effective modality to reduce your pain and swelling. Please apply for 20-30 minutes each 2 to 4 hours during the initial phase or when you notice that your injury is warm or hot. Most children can tolerate paracetamol as a pain reducing medication. Check with your doctor. To support and protect your heels, you may need to be wear shock absorbing heel cups or a soft orthotic. Kinesio foot taping may help to provide pain relief. Your physiotherapist will guide you and utilise a range of pain relieving techniques including joint mobilisations for stiff ankle or subtalar joints, massage or electrotherapy to assist you during this pain-full phase.
Sever?s disease is self-recovering, meaning that it will go away on its own when the foot is used less or when the bone is through growing. The condition is not expected to create any long-term disability, and expected to subside in 2-8 weeks. The disease may also take several years to stop, because it is often triggered by growing too fast. It is more common in boys, although occurs in girls as well. The average age of symptom onset is 9-11.